Maternal smoking linked to higher incidence of congenital heart defects in offsprings

Maternal cigarette smoking in the first trimester was associated with a 20 to 70 percent greater likelihood that a baby would be born with certain types of congenital heart defects, according to a study by the Centers for Disease Control and Prevention. Congenital heart defects are the most common type of birth defects, contributing to approximately 30 percent of infant deaths from birth defects annually.
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http://www.cdc.gov/media/releases/2011/p0228_smokingpregnancy.html?source=govdelivery

Polycystic Ovarian Syndrome

Dr Deepika Tiwari, Gynecologist, Gurgaon

Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. High serum concentrations of androgenic hormones, such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S), may be encountered in these patients.
PCOS is also associated with peripheral insulin resistance and hyperinsulinemia, and obesity amplifies the degree of both abnormalities.
Patients with PCOS may present with various clinical features.
Menstrual abnormalities/ Hyperandrogenism/ Infertility/ Obesity/ Diabetes mellitus/ Sleep apnea/ Metabolic syndrome
Treatment:
Diet and exercise: In patients with PCOS who are obese, endocrine-metabolic parameters markedly improve after 4-12 weeks of dietary restriction. 
Metformin: This antidiabetic drug improves insulin resistance and decreases hyperinsulinemia in patients with PCOS
Patients with PCOS who are infertile but desire pregnancy should be referred to a reproductive endocrinologist for further evaluation and management of infertility.

Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/

Intrauterine Contraceptive Devices IUCD or IUD

 An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed. However, an IUD should only be removed by a medical professional.

Hormonal and copper IUDs work in different ways. With a copper IUD, a small amount of copper is released into the uterus. This type of IUD does not affect ovulation or the menstrual cycle. Copper IUDs prevent sperm from being able to go into the egg by immobilizing the sperm on the way to the fallopian tubes. If an egg does become fertilized, implantation on the wall of the uterus is prevented because copper changes the lining of the uterus.

With hormonal IUDs, a small amount of progestin or a similar hormone is released into the uterus. These hormones thicken cervical mucus and make it difficult for sperm to enter the cervix. Hormonal IUDs also slow down the growth of the uterine lining, making it inhospitable for fertilized eggs.

Before an IUD is placed, a physical examination is important to make sure that the reproductive organs are normal and that no infections are present.

An IUD can be placed during an office visit and remains in place until a medical professional removes it. It can be inserted at any phase of the menstrual cycle, but the best time is right after the menstrual period because this is when the cervix is softest and when women are least likely to be pregnant.

Once the IUD is placed, women can return to normal activities such as sex, exercise, and swimming as soon as they are comfortable. Strenuous physical activity does not affect the position of the IUD.

Ref : MEDSCAPE

Dr Deepika Tiwari, Gynecologist, Gurgaon 
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/www.deepikatiwari.com

Emergency Contraception Pill or "Morning after" pill

 Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Emergency contraceptive pills are sometimes called the “morning-after pill,” but they are usually effective if taken within 72 hours of unprotected sexual intercourse.  

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse to reduce the possibility of pregnancy. A woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary). Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. They are not as effective as any ongoing contraceptive method.


Emergency contraception pills contain high doses of the same hormones that are in birth control pills. The high dose of hormones is short lived. Cases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method. These pills are not designed to terminate an existing pregnancy.


Emergency contraception pills should only be taken with expert opinion. Cases of Uterine rupture have been reported in patients with inadvertent use.


Ref: Medscape
Dr Deepika Tiwari, Gynecologist, Gurgaon 9911821669
www.gurgaongynae.in
http://www.drdeepikatiwari.blogspot.com/
http://www.gurgaongynecologist.webs.com/

Abruptio Placentae : Bleeding in Pregnancy

Dr Deepika Tiwari, Gynecologist, Gurgaon

Abruptio placentae, also called premature separation of the  placenta, is a serious complication of pregnancy. The placenta separates away from the inner wall of the uterus before delivery. Untreated abruption can harm both mother and baby. It can mean compromised oxygen and nutrients for the baby and heavy bleeding in the mother.  It’s a medical emergency.

Risk factors include hypertension, trauma, and multiple pregnancies. Abnormalities of pregnancy called chorioamnionitis and polyhydramnios are also risk factors. Others are age (younger than 20 and older than
35), preeclampsia, diabetes, smoking, use of cocaine, and alcohol consumption.


The main symptoms are uterine bleeding, abnormal uterine contractions, and fetal distress . Contractions are painful and obvious. Weakness, low blood pressure, fast heart rate, abdominal pain, and back pain may occur. Grade 1 abruption includes mild bleeding from the vagina and uterine contractions, stable vital signs, and stable fetal heart rate. Grade 2 means moderate bleeding, abnormal contractions, low blood pressure, distressed fetus, and abnormal coagulation profile. Grade 3 is worst. It involves severe bleeding and contractions, very low blood pressure, fetal death, and very poor coagulation profile.


Treatment :Stabilization of the mother is done first. Intravenous fluids  are given to maintain blood pressure and keep the urine flow steady. An emergency cesarean section and blood transfusions may be needed. For almost full-term babies and mild abruption, vaginal delivery may be possible.